Healthcare professionals and partners

All staff with a responsibility for completing the TOP should be aware that: 

1. The Treatment Outcome Profile (TOP) was designed alongside wide consultation in the field. It provides clinicans and clients with an additional tool to see if their current care plan is working and commissioners with more suitable information to assess the impact of treatment
2. It is good practice to conduct regular care plan reviews that are usually completed in 12 week (3 month) cycles. It is recommended that the TOP is completed as part of this process
3. When completing the TOP NA means 'Not Answered'. Use NA when the client can't remember something of refuses to disclose information relating to a specific item or all items in the TOP
4. Section 1 should report all illict drug use. This includes methadone and buprenorphine (subutex) bought on the street rather than by prescription. These should be recorded in the opiates section of the TOP form.
5. Information about clients collected using the TOP is subject to the same confidentiality safe guards as all other drug treatment and health data. It is important that clients feel reassured of this fact to enable accurate reporting of behaviour

In August 2009 the NTA announced that the window for reporting the Review TOP (see the TOP reporting protocol below) to the NDTMS has been widened.

It is important to note that the changes in frequency of TOP Reviews relate only to the NDTMS reporting requirements and do not reflect our position on completing TOP as part of the care plan review process. The TOP has been developed around the care plan review process and completion should continue in line with this, however, TOP Reviews only need reporting to the NDTMS every 26 weeks (6 months).

The TOP should be completed at three key treatment stages:

Treatment Start
The TOP should be completed within two weeks either side of the date that a client started structured drug treatment. If the TOP is completed in the two weeks after the treatment start date it is important to ensure that the recall period focuses on the 28-days before treatment start and NOT the 28-days from the date that the TOP is completed. The treatment start TOP provides important information about the clients drug use before treatment and acts as a baseline for comparison with subsequent Review and Exit TOPs.

Review TOP
It is good practice to conduct regular care plan reviews that are usually completed in 12 week (3 month) cycles. It is recommended that the TOP is completed as part of this process. However, the TOP only needs reporting to the NDTMS every 26 weeks (6 months). 

Treatment Exit
TOP should be completed within two weeks either side of the date that the client exits structured treatment. If the client is referred on to another structured treatment provider a Treatment Exit TOP is not required.

Reporting the TOP to NDTMS
Despite the recent widening of the window for reporting the Review TOP (see reporting protocol), DAT partnerships are still able to submit TOP review data more frequently (i.e. every 12 weeks). This may help to increase the partnerships overall TOP compliance, however, only data from the latest TOP will be used for routine analysis (exception reports, level 0-3 reports).
 

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The Treatment Outcomes Profile (TOP) was developed by the NTA in collaboration with Dr John Marsden and Dr Michael Farrell of the National Addiction Centre, Institute of Psychiatry, Kings College, London.

The items that appear in the TOP were psychometrically evaluated and demonstrated an acceptable level of reliability and validity. This evaluation is available in the peer review journal Addiction. The abstract, and reference to the full article are available below.

ABSTRACT
Aim
To develop the Treatment Outcomes Profile (TOP), a new instrument for monitoring substance misuse treatment.

Design
Prospective cohort, psychometric evaluation with 7-day retest and 1-month follow-up to assess inter-rater reliability, concurrent, discriminant and construct validity, and change sensitivity.

Participants
A sample of 1021 service users, aged 16–62 years. Recruitment from 63 treatment agencies in England, collectively providing opioid substitution treatment, psychosocial interventions, in-patient detoxification and residential rehabilitation.

Measurements
Thirty-eight frequency, rating scale and period prevalence measures, with 28-day recall, across substance use, health, crime and social functioning domains, administered as personal interview by 163 treatment keyworkers.

Findings
Twenty outcome measures met inter-rater reliability criteria: days used alcohol, opioids, crack cocaine, cocaine powder, amphetamines, cannabis and one other named substance; days injected and period prevalence of direct or indirect needle/syringe sharing; subjective rating of physical and psychological health; days committed shop theft and drug selling, period prevalence of vehicle, property, fraud/forgery and assault/violence offences; rating of quality of life; days worked and attended for education/training; and period prevalence of acute housing problems and risk of eviction. Intraclass correlation coefficients for scale measures and Cohen’s kappa for dichotomous measures reached or exceeded 0.75 and 0.61, respectively. There were satisfactory validity assessments and change sensitivity of scale items judged by effect size and smallest detectable difference. The TOP clinical tool contains an additional 10 items for individual treatment planning and review.

Conclusions
The TOP is a reliable and valid 20-item instrument for treatment outcomes monitoring. 

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TOP compliance refers to the number of clients that are accessing structured treatment who have had a TOP completed (in accordance with the published protocol) at the key stages of their treatment journey.

The threshold for TOP compliance is 80%. This means that a TOP is expected at each treatment stage for at least 80% of the clients that are accessing, retained in or exiting structured drug treatment.

Why 80%?
The TOP is the first drug treatment outcomes measure to have been implemented throughout an entire national drug treatment system, therefore, making it the largest outcomes dataset in the world.

The NTA must ensure that any analysis of the TOP dataset is robust, accurately undertaken and representative of the local treatment system.

If an insufficient quantity of TOP data is received then any analysis conducted may distort the true picture of the local treatment system and show that providers and partnerships are doing better or worse than is really the case.

To help avoid any incorrect interpretations of the data, we must be able to say with confidence that the information is representative of the treatment system.

The 80% threshold is widely employed in follow-up research studies to ensure that a particular study sample is representative of the population it seeks to study. If this criterion cannot be satisfied then it is possible that the findings of the study will be distorted by error arising from a biased sample.

Not reached 80%?
The NTA are committed to working with DAT Partnerships to help them reach the acceptable level of compliance.

Any partnership that is yet to reach this threshold may benefit from conducting a TOP audit. The NTA have developed a TOP self-audit tool that suggests a process for conducting a TOP audit at partnership level, and has been developed to support local improvements in the implementation of the TOP.
 

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It is ethically important that a statement regarding confidentiality is conveyed to each client at each TOP interview.

The TOP data submitted via NDTMS will have the same safeguards in relation to confidentiality as any other item within the NDTMS core data set. This should be carefully explained to the client and local confidentiality agreements should be modified as appropriate to take into account the introduction of TOP into clinical and reporting systems. Please refer to the confidentiality and information sharing and data protection and record retention documents available here.

Concerns
Since the implementation of the TOP a series of questions have been raised about client confidentiality and the applicability of some the TOP questions with particular reference to crime.
In response NTA has actively followed up these concerns as they have arisen with the relevant professional body. This has included:

Department of Health: Digital Policy Unit (DPU)
British Medical Association (BMA)
General Medical Council (GMC) & British Medical Association (BMA)

The minutes of each meeting are available by clicking on each of the links above.

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The TOP products and guidance available for 2010. 

• TOP DET guide
• TOP protocol: A keyworkers guide’
• TOP introduction for new staff
• TOP key points
• TOP clinical usefulness
• TOP validation

The products listed on this section are currently being updated to reflect the progress that has been made with the TOP.

• TOP form
• TOP manager's implementation guide
• TOP keyworker's guide
• TOP training pack: presentation and manual
• NDTMS practice guide
• TOP calendar
• TOP poster
• TOP progress tracker
• TOP tracker guidance
• TOP self audit tool
• TOP service user's guide: Farsi, Latvian, Polish, Portuguese, Urdu, Nepalese